Written by: Trudi Griffin is a NCC Licensed Professional Counselor and part of the trichstop.com team.
Trichotillomania & OCD
Trichotillomania is related to obsessive-compulsive disorder (OCD), but there are several diagnostic features that differentiate the two disorders.
Diagnostic criteria: Trichotillomania
First, trichotillomania is a compulsion to pull one’s hair recurrently, resulting in hair loss. Hair is pulled from any area of the body, the most common areas are the scalp, eyebrows, and eyelids. Episodes of hair pulling vary over time and can be cyclical, but a person will spend a considerable amount of time doing it, sometimes several hours per day.
Another key diagnostic feature is recurring attempts to stop or decrease hair-pulling behaviors.
Also, the behavior causes significant distress in a person’s life. This distress causes dysfunction at school, work, or in social settings are other areas of functioning. Finally, the compulsion to pull hair cannot be explained by another medical problem or another mental health problem.
Trichotillomania is a disorder that affects 1-2% of the population, mostly female, typically starting in adolescence with the onset of puberty. The disorder is considered chronic.
Diagnostic criteria: Obsessive-compulsive disorder (OCD)
First, OCD is recognized by the presence of obsessions, compulsions, or both.
Obsession – Recurrent or persistent thoughts, urges, or images that are intrusive, unwanted, and cause significant anxiety or distress. A person attempts to ignore or suppress them or to neutralize them with some other thought or action. Actions usually take the form of compulsions.
Compulsion – Repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession or according to rigid rules. The behaviors and mental acts serve the purpose of preventing or reducing anxiety, distress or a dreaded event or situation. The behaviors and mental acts are not realistic with what they are supposed to neutralize or prevent, or they are excessive.
Second, the obsessions or compulsions are time-consuming, often more than one hour per day. They are significantly distressing and cause impairment in social, occupational, or other areas of functioning. In other words, they interfere with daily life. Third, the obsessive-compulsive symptoms are not due to physiological effects of a substance, such as drugs, or any other medical condition. Lastly, another mental disorder does not explain the obsessive-compulsive symptoms such as anxiety, a body-focused repetitive behavior, stereotypical movement disorder, substance use, or psychotic disorders.
Symptoms begin to show up gradually, usually in adolescence and young men show signs earlier than young women. If left untreated, OCD is chronic and symptoms usually cycle through periods of strength and weakness. If OCD starts in childhood or adolescence, it is likely that it will last a lifetime. This disorder is considered to be heritable, meaning that it tends to run in families. Approximately 1.2% of the population is afflicted with OCD and it is often accompanied by another disorder such as anxiety or depressive disorder.
Both disorders cause distress and a key feature of both of them before they can be properly diagnosed is that it causes significant impairment. People who struggle with OCD or trichotillomania spend a lot of time, several hours per day on their obsessions or compulsions. It interferes with going to school or work, keeping friendships or relationships, and participating in hobbies. Despite trying to stop, nothing works.
The main difference is that people with trichotillomania disorder are often triggered by stress, boredom, or tension and pulling hair alleviates the stress, boredom, or tension. Some report it results in relief, gratification or pleasure, others do not. Sometimes hair pulling is a focused activity done with intention and other times it is done without conscious awareness. Most people do it in private and experience negative feelings of embarrassment or shame if others notice it. The pulling of hair is primary, on its own, and not the result of an obsession. If someone with OCD engages in hair pulling, it is usually in response to an obsession or compulsion and the obsession or compulsion does not go away.
The diagnostic criteria state that each disorder is chronic and symptoms never truly go away. With specialized therapy, however, symptoms can be managed and some people who suffer from trichotillomania say they are able to manage symptoms to the point where they feel free from the disorder. Either way, treatment and support is available so neither disorder has to run someone’s life.